Open Enrollment Period in North Carolina

• Open Enrollment 2025: November 1, 2024 – January 15, 2025
  You can:

• Enroll in a new plan

• Switch plans

• Renew your current policy

Special Enrollment Period (SEP)

Qualifying life events that trigger SEP include:

• Marriage or divorce

• Loss of employer-sponsored coverage

• Birth or adoption of a child

• Moving to a different ZIP code or county

• Change in income or household size

Types of Health Insurance Plans Available in North Carolina

Plans are categorized into:

• Bronze: Lowest premiums, highest cost-sharing

• Silver: Balanced premiums and costs; eligible for CSR

• Gold: Higher premiums, lower out-of-pocket costs

• Platinum: Highest monthly premiums, lowest costs when you receive care

Plan Formats:

• HMO (Health Maintenance Organization) – Lower premiums, referrals required

• PPO (Preferred Provider Organization) – Higher flexibility, no referrals

• EPO (Exclusive Provider Organization) – No referrals, but in-network care only

Catastrophic Plans are available for those under age 30 or with hardship exemptions.

Eligibility for Subsidies and Cost Assistance in North Carolina

• Premium Tax Credits: For incomes between 100% and 400% of the Federal Poverty Level (FPL)

• Cost-Sharing Reductions (CSR): Available with Silver plans for incomes up to 250% FPL

• Medicaid Expansion: As of December 2023, North Carolina has expanded Medicaid, covering adults earning up to 138% of FPL

• NC Health Choice (CHIP): Provides health coverage for children in low- and middle-income families

How to Compare and Choose a Plan in North Carolina

What to consider:

• Premiums vs. deductibles

• Copays, coinsurance, and out-of-pocket limits

• Prescription formularies

• In-network doctors and hospitals (especially in Raleigh, Charlotte, Greensboro, Asheville)

Tips:

• Freelancers should estimate annual income carefully for subsidy eligibility

• Families may split coverage (adults on Marketplace, kids on NC Health Choice)

• Early retirees should compare ACA plans to COBRA

Top Insurance Providers on the North Carolina Marketplace

Available insurers include:

• Blue Cross and Blue Shield of North Carolina (Blue Cross NC)

• Ambetter of North Carolina

• Cigna Healthcare

• Oscar Health

• Aetna CVS Health

• UnitedHealthcare (limited areas)

Plan availability varies by county.

Navigating North Carolina’s Online Enrollment Portal

To apply:

Go to HealthCare.gov

Create an account

Enter household details and estimated income

View available plans and enroll

Need assistance? Use this local help tool to find certified agents and navigators across North Carolina.

Alternatives to the Marketplace in North Carolina

• Short-Term Health Insurance: Available for up to 364 days; limited benefits

• Off-Exchange Plans: Direct from insurers (not eligible for subsidies)

• Faith-Based Health Sharing Ministries: Legal in North Carolina, but not regulated as insurance

Common Mistakes to Avoid During Enrollment

• Forgetting to update your income

• Missing the January 15 enrollment deadline

• Choosing a Bronze plan with high deductibles despite regular care needs

• Failing to review provider networks

• Assuming all family members qualify for the same plan type or program

North Carolina-Specific Health Programs or Initiatives

• Medicaid Expansion (Effective Dec. 1, 2023): Expands coverage to low-income adults under 138% FPL

• NC Health Choice (CHIP): Provides children with dental, vision, and medical coverage

• Integrated Telehealth Options: Most ACA plans in NC now offer virtual care and telemedicine

• Outreach Support: Many local organizations assist with bilingual enrollment support